Nurse Program During Pregnancy Reduces Child's Criminality

Girls whose mothers were visited at home by nurses during pregnancy and the children's infancy appear less likely to enter the criminal justice system by age 19, according to a report in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

John Eckenrode, Ph.D., of Cornell University, Ithaca, N.Y., and colleagues studied 310 19-year-olds whose mothers were enrolled in the Nurse-Family Partnership program in Elmira, N.Y., in which nurses visited homes to help women improve health-related behaviors during pregnancy, provide more competent care during infancy and improve their economic self-sufficiency through appropriate life choices. A total of 400 pregnant women enrolled in the study between 1978 and 1980; 85 percent of them were age 19 or younger, unmarried or from households with low socioeconomic status.

Of the 310 families followed up when the children were 19 years of age, 140 were in the control group, 79 received visits during pregnancy only and 91 received visits during pregnancy and infancy. Families in the program received an average of nine home visits by nurses during pregnancy and 23 from birth through the child's second birthday.

Compared with the 73 in the comparison group, the 44 girls whose families were visited during pregnancy and infancy were less likely to have been arrested by age 19 (10 percent vs. 30 percent) or convicted (4 percent vs. 20 percent), and had fewer lifetime arrests (an average of 0.1 vs. 0.54) and convictions (0.04 percent vs. 0.37 percent). When the analysis was restricted to girls whose mothers were high-risk (unmarried or low-income), those who were visited by nurses had fewer children (11 percent vs. 30 percent) and were less likely to use Medicaid (18 percent vs. 45 percent) than those who were not visited.

For boys, the likelihood of an arrest increased significantly in both the intervention and control groups after age 12, with no difference in arrests between groups through age 19.

"In the current debate over health care reform, the question of the cost vs. benefit of investing in prevention has become a hot topic," writes J. David Hawkins, Ph.D., of the University of Washington, Seattle, in an accompanying editorial.

"The Nurse-Family Partnership Program costs about $7,000 per child. Benefit-cost analyses for the already published effects of the program have found that it produces total benefits of about $41,000 per child of low-income, unmarried, nurse-visited mothers and about $9,000 per child of lower-risk nurse-visited mothers, a positive benefit-cost ratio in both cases."

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